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Elariny AF, Ghozlan N, Wasief S, Moussa AE, Eldeeb ME. Evaluation of efficacy of follicular unit extraction versus follicular unit extraction with platelet rich plasma in treatment of cicatricial alopecia. J Cosmet Dermatol 2022; 21:5931-5937. [PMID: 35791055 DOI: 10.1111/jocd.15213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/31/2022] [Accepted: 06/21/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Follicular unit extraction (FUE) is a minimally invasive surgery that is becoming popular in hair restoration in cicatricial alopecia (CA). AIM Evaluation of FUE with or without platelet rich plasma (PRP) in scarring alopecia. PATIENTS AND METHODS Twenty patients with CA were randomized into two groups. Group A (10 patients) underwent FUE, group B (10 patients) underwent FUE + PRP. PRP was injected 1 week before surgery, then monthly after surgery for 3 months. Follow up was done after 3, 6 and 12 months by calculating the density of surviving follicular units and the survival rate. RESULTS In group A, there was statistically significant increase in mean survival rate which was 30.30%. At 3 months, 67.26% at 6 months and 78.15% at 12 months. In group B, there was a significant increase in mean survival rate being 30.14% at 3 months, 58.75% at 6 months and 69.74% at 12 months. There was no significant difference between both groups at anytime during follow up period. CONCLUSION Follicular unit extraction is a preferred procedure for hair restoration in CA with few side effects. The role of PRP in HT is controversial. In the present study, PRP does not significantly affect the survival rate of hair grafts.
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Affiliation(s)
- Ali Fouad Elariny
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Nasser Ghozlan
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sherif Wasief
- Department of Plastic Surgery, Shark El Madina Hospital, Alexandria, Egypt
| | - Aya Elsayed Moussa
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Marwa Elsaeed Eldeeb
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Svigos K, Yin L, Fried L, Lo Sicco K, Shapiro J. A Practical Approach to the Diagnosis and Management of Classic Lichen Planopilaris. Am J Clin Dermatol 2021; 22:681-692. [PMID: 34347282 DOI: 10.1007/s40257-021-00630-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 12/01/2022]
Abstract
Lichen planopilaris is a primary lymphocytic cicatricial alopecia that commonly presents with hair loss at the vertex or parietal scalp. Patients may also have associated scalp itching, burning or tenderness. Due to scarring, hair loss is typically permanent. The main goals of treatment are reducing symptoms and preventing disease progression and further hair loss. Currently, the literature has limited evidence on treatments for this difficult condition, and most available evidence is from case reports and case series. Furthermore, the evidence shows a varied response to therapy, with frequent reports of poor response. This article reviews the diagnosis of this rare disease, summarize the currently available treatments, and provide insights and practices from alopecia experts.
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Affiliation(s)
- Katerina Svigos
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Lu Yin
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Lauren Fried
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Kristen Lo Sicco
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA.
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Long-Term Utility of Follicular Unit Excision in Lichen Planopilaris-Correlation of Graft Survival With Histopathological and Ultrasound Biomicroscopic Parameters. Dermatol Surg 2021; 47:1243-1248. [PMID: 34115675 DOI: 10.1097/dss.0000000000003103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hair transplantation in scarring alopecia is challenging and transplant surgeons are hesitant due to fear of poor graft survival apart from the risk of reactivating the disease. OBJECTIVE Survival rate of hair follicles transplanted in cases of lichen planopilaris (LPP). To correlate histopathological and ultrasonography findings and their impact on graft survival. METHODS In 32 patients of inactive LPP included, a 5-cm2 recipient area was tattooed. The follicular unit density of the transplanted area was 20 to 25 FU/cm2. Postoperative follow-up was conducted at 6, 12, and 24 months. The recipient area density and ultrasound biomicroscopic parameters were assessed at each follow-up visit. RESULTS The survival of grafts was 78.62% at 12 months, and 79.96% at 24 months. Histopathology variables studied at the time of transplantation such as epidermal atrophy, fibrosis, and inflammatory infiltrate were not found to have any effect on the graft survival. Ultrasonography parameters of the involved scalp skin were found to be markedly improved on follow-up. This suggests that the overall health of the scalp improved after hair transplantation. CONCLUSION Follicular unit excision is a ray of hope for cases of primary cicatricial alopecia such as LPP because the result is satisfying to both the patient as well as the doctor.
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Kerure AS, Deshmukh N, Agrawal S, Patwardhan NG. Follicular Unit Extraction [FUE] - One Procedure, Many Uses. Indian Dermatol Online J 2021; 12:381-388. [PMID: 34211903 PMCID: PMC8202483 DOI: 10.4103/idoj.idoj_522_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/14/2020] [Accepted: 10/05/2020] [Indexed: 11/04/2022] Open
Abstract
Follicular unit extraction [FUE] is a minimally invasive hair restoration surgery popularly known for its utility in androgenetic alopecia (AGA). In FUE, individual follicular grafts are extracted from donor area and implanted in the recipient area. Advantages of FUE are that it is comparatively 'scarless', has faster healing time, has less downtime and requires less technical staff. This article is aimed to highlight upon the multi-faceted utility of FUE technique in various dermatological indications like androgenetic alopecia, alopecia areata, facial hair restoration, tractional alopecia, scarring alopecia, body hair transplant, vitiligo as well as hirsutism.
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Affiliation(s)
- Amit S. Kerure
- Consultant Dermatologist and Hair Transplant Surgeon, Dr Amit Kerure Skin Clinic, Sector 9, Vashi, Navi Mumbai, India
| | | | - Sandeep Agrawal
- Department of Dermatology, IGGMC, Nagpur, Maharashtra, India
| | - Narendra G. Patwardhan
- Consultant Dermatologist and Hair Transplant, Joshi Multispeciality Hospital, Maharashtra Medical Foundation, Pune, Maharashtra, India
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Madura C, Vinay N, Kusuma MR, Harsha S, Chandrashekar BS. The assessment of Hair Transplantation Outcomes in Cicatricial Alopecia. Int J Trichology 2020; 12:164-167. [PMID: 33376285 PMCID: PMC7759062 DOI: 10.4103/ijt.ijt_52_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/17/2020] [Indexed: 01/06/2023] Open
Abstract
Background Cicatricial alopecia (CA) is scarring alopecia due to a diverse group of disorders which destroy the hair follicle, replace it with scar tissue causing permanent hair loss. Spontaneous regrowth of hair in CA is rarely seen and thus it has a negative impact on the self-esteem of the patient. However, hair transplantation (HT) has emerged as an effective modality of treatment to replace lost hair for cosmetic benefit. Materials and Methods This was a prospective analysis of patients affected with CA, who underwent HT from January 2015 to December 2017. Demography of patients along with the duration of disease, stability, biopsy, technique of HT, number of grafts, and other procedures done were noted on a pro forma and analyzed. A test patch of HT was done in all primary CA to assess stability and few secondary CA to look for graft uptake. The patients were followed up for a year and the outcomes were graded by patient and a single observer on a 10 point scale as poor, satisfactory, good, and very good at 3, 6, and 12 months. Results A total of 50 patients with CA underwent follicular unit extraction. Majority of them were males(84%) with a male to female ratio of 5.25:1. Secondary CA was seen in majority(90%) of the study group. Moustache (56%) was the most common site affected, followed by scalp (22%), beard(14%) and eyebrow(8%). Around 38%(12 atrophic scars; 7 hypertrophic scars) underwent fractional CO2 laser/Erbium YAG laser with or without intralesional steroid injections in a stepwise manner prior to HT. Excellent-to-very good outcome was seen in 82% while 18% were lost for follow up. Conclusion Scarring in CA has a significant effect on quality of life of affected patients. HT when done taking into consideration the stability of disease has good-to-excellent outcomes thus leading to a positive impact on the patient's life.
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Affiliation(s)
- C Madura
- Department of Dermatosurgery, CUTIS Academy of Cutaneous Sciences, MRCR Layout, Bengaluru, Karnataka, India
| | - N Vinay
- Department of Dermatosurgery, CUTIS Academy of Cutaneous Sciences, MRCR Layout, Bengaluru, Karnataka, India
| | - M R Kusuma
- Department of Dermatosurgery, CUTIS Academy of Cutaneous Sciences, MRCR Layout, Bengaluru, Karnataka, India
| | - S Harsha
- Department of Dermatosurgery, CUTIS Academy of Cutaneous Sciences, MRCR Layout, Bengaluru, Karnataka, India
| | - B S Chandrashekar
- Department of Dermatosurgery, CUTIS Academy of Cutaneous Sciences, MRCR Layout, Bengaluru, Karnataka, India
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Whittle C, Castro A, Larrondo J. Images in Scalp Ultrasound Before and After Hair Transplant in Frontal Fibrosing Alopecia. Ultrasound Q 2019; 37:87-89. [PMID: 31725066 DOI: 10.1097/ruq.0000000000000473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Primary cicatricial alopecias are inflammatory scalp conditions that may lead to permanent hair loss and severe alopecia. Frontal fibrosing alopecia is one of the most frequent etiologies of primary cicatricial alopecias. Hair transplant could be a therapeutic option.High-resolution ultrasound (US) is an imaging technique useful for evaluating scalp with adequate differentiation of the skin layers. Also, hair follicles are visualized.The objectives are present presurgical and posttransplant scalp US studies on hair transplant.Frontal fibrosing alopecia is a chronic entity that can progress to extensive irreversible alopecia. Hair transplant is a surgical option. On US, the hair follicles are visualized as thin hypoechoic lines. With Doppler color imaging, it is possible to evaluate vascularization. In this experience, we can observe the follicles of the compromised area before and after the hair transplant and the depth of the implanted follicles.In conclusion, US impresses as a promissory technique for the imaging of hair transplant. More experience is necessary for a better approach of these findings.
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Affiliation(s)
| | - Alex Castro
- Pathology Department, Clínica Alemana, Facultad de Medicina Clinica Alemana, Universidad del Desarrollo
| | - Jorge Larrondo
- Dermatology Unit, Clínica Alemana de Santiago, Santiago, Chile
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Iorizzo M, Tosti A. Frontal Fibrosing Alopecia: An Update on Pathogenesis, Diagnosis, and Treatment. Am J Clin Dermatol 2019; 20:379-390. [PMID: 30659454 DOI: 10.1007/s40257-019-00424-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Frontal fibrosing alopecia (FFA), first described by Kossard in the early 1990s, is a form of primary lymphocytic cicatricial alopecia characterized by selective involvement of the frontotemporal hairline and eyebrows. Since the original description, an increasing number of cases have been reported worldwide and the clinical aspects of the disease have been better characterized. However, the pathogenesis is still unknown and several hypotheses have been made about possible triggering factors, including hormones, neurogenic inflammation, smoking, UV filters, and ingredients in leave-on facial products. A genetic basis has also been hypothesized as the disease can occur in siblings and members of the same family. Besides its pathogenesis, research is also focused on treatment; FFA is a chronic condition and at present there is no validated or approved treatment for this disorder. Commonly prescribed topical treatments include corticosteroids, minoxidil, and calcineurin inhibitors. Systemic treatments include 5α-reductase inhibitors, hydroxychloroquine, and retinoids. Intralesional triamcinolone acetonide is also utilized, especially for the eyebrows. Other possible treatments include pioglitazone, naltrexone, tofacitinib, and lasers.
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Affiliation(s)
- Matilde Iorizzo
- Private Dermatology Practice, Viale Stazione 16, 6500, Bellinzona, Switzerland.
| | - Antonella Tosti
- Fredric Brandt Endowed Professor of Dermatology, Miller School of Medicine, University of Miami, Miami, FL, USA
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Almohanna HM, Perper M, Tosti A. Safety concerns when using novel medications to treat alopecia. Expert Opin Drug Saf 2018; 17:1115-1128. [PMID: 30318935 DOI: 10.1080/14740338.2018.1533549] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Alopecia is often a cause of great concern to patients for cosmetic and psychologic reasons. The aim of treating non-scarring alopecias is to reduce hair loss and, to some extent, enhance hair regrowth. However, therapies for scarring alopecias are limited and aiming to halt disease progression. Nonetheless, available modalities of treatment come with numerous side effects. Areas covered: Many new treatments for non-scarring alopecias have been introduced in recent years. This review summarizes the safety concerns when using novel therapeutic modalities such as JAK inhibitors, hair transplantation, mesotherapy, oral minoxidil, platelet-rich plasma, microneedling, and 5α-reductase inhibitors for treating hair loss. A broad literature search was performed using PubMed and Google Scholar in April 2018 to compile published articles that reported the adverse effects of new therapeutic modalities for alopecia. Expert opinion: Although emerging therapeutic modalities for alopecia have demonstrated efficacy in hair regrowth and treating established disease, their safety profiles vary widely. When considering the new treatments for alopecia, physicians should weigh the potential benefits and risks of each treatment or combination treatment to ensure safe and successful outcomes.
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Affiliation(s)
- Hind M Almohanna
- a Department of Dermatology and Dermatologic Surgery , Prince Sultan Military Medical City , Riyadh , Saudi Arabia
| | - Marina Perper
- b Department of Dermatology and Cutaneous Surgery , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Antonella Tosti
- b Department of Dermatology and Cutaneous Surgery , University of Miami Miller School of Medicine , Miami , FL , USA
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Kasai Y, Igawa H, Abe N, Sakamoto A, Tsushima A, Narui Y, Yokohari K. Successful follicular unit extraction hair transplant for bald area after skin graft. JPRAS Open 2017. [DOI: 10.1016/j.jpra.2017.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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10
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Zhang Q, Zu T, Zhou Q, Wen J, Leng X, Wu X. The patch assay reconstitutes mature hair follicles by culture-expanded human cells. Regen Med 2017; 12:503-511. [PMID: 28749726 DOI: 10.2217/rme-2017-0017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
AIM We tested whether the a simple injection known as the patch assay could reconstitute mature hair follicles by culture-expanded human cells and explored whether the assay could reflect the trichogenicity of cultured cells. MATERIALS & METHODS Dissociated culture-expanded fetal or adult scalp dermal cells combined with foreskin keratinocytes were subcutaneously injected into the back skin of immunosuppressive mice to form the patch skin. The patches were collected and characterized and were analyzed for hair formation efficiency. RESULTS Using culture-expanded human fetal cells, the patch assay can efficiently reconstitute mature hair follicles and the efficiency of hair formation in the patch assay correlates with cell trichogenicity. CONCLUSION The patch assay has the potential for testing the trichogenicity of human cells.
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Affiliation(s)
- Qun Zhang
- Suzhou Institute of Shandong University, Building H of NUSP, 388 Ruoshui Road, Suzhou Industrial Park, Suzhou, Jiangsu, China.,School of Stomatology, Shandong University, Jinan, Shandong China
| | - Tingjian Zu
- School of Stomatology, Shandong University, Jinan, Shandong China
| | - Qian Zhou
- School of Stomatology, Shandong University, Jinan, Shandong China
| | - Jie Wen
- School of Stomatology, Shandong University, Jinan, Shandong China
| | - Xue Leng
- School of Stomatology, Shandong University, Jinan, Shandong China
| | - Xunwei Wu
- Suzhou Institute of Shandong University, Building H of NUSP, 388 Ruoshui Road, Suzhou Industrial Park, Suzhou, Jiangsu, China.,School of Stomatology, Shandong University, Jinan, Shandong China
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